HomeMy WebLinkAboutProject Self-Sufficiency (PS-S) - 2018-02-05 Dept. ID CS 18-001 Page 1 of 2
Meeting Date:2/5/2018
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CITY OF HUNTINGTON BEACH
REQUEST FOR. CITY COUNCIL ACTION
MEETING DATE: 2/5/2018
SUBMITTED TO: Honorable Mayor and City Council Members
SUBMITTED BY: Fred A. Wilson, City Manager
PREPARED BY: David Dominguez, Acting Director of Community Services
SUBJECT: Approve and authorize execution of a Memorandum of Understanding (MOU)
between the City of Huntington Beach and Project Self-Sufficiency (PS-S)
Statement of Issue:
There is a need to approve a Memorandum of Understanding with Project Self-Sufficiency to
formalize their relationship with the City of Huntington Beach.
Financial Impact:
Not applicable.
Recommended Action:
Approve and authorize the Mayor and City Clerk to execute a "Memorandum of Understanding
Between the City of Huntington Beach and Project Self-Sufficiency."
Alternative Action(s):
Do not approve the recommended action and direct staff accordingly.
Analysis:
The City of Huntington Beach (City) began operating the Project Self-Sufficiency program in
1985 through a U. S. Housing and Urban Development Grant. The City worked with
community volunteers to form the Project Self-Sufficiency Foundation, a 501 c3, and in
1994 began a Public/Private partnership.
The City has requested that the Project Self-Sufficiency Foundation (recently renamed
Project Self-Sufficiency) operate the Project Self-Sufficiency program independently as a
501c3 and separate from the City and from City General Fund support.
The City and Project Self-Sufficiency (PS-S) want to enter into a Memorandum of Understanding
(MOU) to support PS-S and to clarify the respective obligations of each.
Key points in the MOU include:
Obligations of CITY:
• Generate pro-rated checks to PS-S for any unspent 2017 Surf City 10 funds, and any unspent
HOAG Memorial Hospital Presbyterian (HOAG)funds obtained for PS-S salaries for 2018 (FY
2017/18) and 2019 (FY 2018/19), as agreed upon in the HOAG MOU.
HB -147- Item 7. - I
Dept. ID CS 18-001 Page 2 of 2
Meeting Date:2/5/2018
• As a City Co-Sponsored event, provide space at the Senior Center in Central Park for the PS-
S Annual Holiday Party, waiving hourly room rental fees and billing for direct event costs only.
City will provide space if available, for additional PS-S meetings and events at the Senior
Center in Central Park in accordance with the City Council approved nonprofit rate.
• Assist PS-S in promoting the transition of the program to a private non-profit agency, utilizing
various marketing tools.
Obligations of PROJECT SELF-SUFFICIENCY:
• Date of separation for all PS-S staff employed by the City of Huntington Beach will be
February 28, 2018.
• In an effort to generate program funding, PS-S will maintain existing collaborative
relationships and develop new partnerships, independent of the City, with current and future
potential philanthropic partners.
• For the duration of this MOU, PS-S will submit a written request for use of City facilities in
advance. Payment of any applicable direct costs will be required.
• PS-S will assist the City in promoting the transition of the PS-S program to a private non-
profit, by providing the City with written articles for various marketing tools.
Environmental Status:
Not applicable.
Strategic Plan Goal:
Improve quality of life
Attachment(s):
1) "Memorandum of Understanding Between the City of Huntington Beach and Project Self-
Sufficiency"
Item 7. - 2 HB -148-
MEMORANDUM OF UNDERSTANDING BETWEEN THE
CITY OF HUNTINGTON BEACH AND
PROJECT SELF-SUFFICIENCY
THIS MEMORANDUM OF UNDERSTANDING ('MOU")is made and
entered into on fiib twe?( ( ,2018,by and between the CITY OF
HUNTINGTON BEACH, a municipal corporation of the State of California
(hereinafter referred to as "City"),and PROJECT SELF-SUFFICIENCY, a non-
profit 5016 Charitable Organization.
WHEREAS, City began operating Project Self-Sufficiency Program
(hereinafter referred to as "Program") in 1985 through a U.S. Housing and Urban
Development Grant; and
The City of Huntington Beach worked with community volunteers to form the
Project-Self Sufficiency Foundation, a 501 c3, and in 1994 began a Public/Private
partnership;and
The City has requested that the Project Self-Sufficiency Foundation operate
the Program independently as a 501 c3, and, separate from the City and from City
General Fund support; and
The Project Self-Sufficiency Foundation wishes to continue to provide a
means to assist highly motivated, low-income single parents to achieve economic
independence; and
The City wishes to provide an in-kind support to Project Self Sufficiency to
demonstrate their belief in the mission of the Program; and
The Project Self-Sufficiency Foundation is now called Project Self-
Sufficiency (hereinafter referred to as "PS-S") and wishes to enter into an agreement
with the City to clarify the respective obligations of City and PS-S;
NOW, THEREFORE, for and in consideration of the promises and covenants
hereinafter contained and intending to be legally bound, the parties covenant and
agree as follows:
1 7-6 1 3 6/1 70422/DO 1
SECTION 1. TERM
This MOU will become effective on the date it is approved by the City
Council of the City and shall be a term of three (3) years. The Agreement shall,
after three years, renew automatically unless either parry submits in writing its
intent to terminate the MOU. In such case, 120 days written notice must be given
of parry's intent to terminate.
SECTION 2. OBLIGATIONS OF CITY
The obligations of City pursuant to this Agreement shall be as follows:
A. On or before April 1, 2018, the City will provide a full accounting of
donated program funds from the 2017 Surf City 10 and will, upon receipt
of an appropriate invoice from PS-S, generate a pro-rata check to PS-S
from City for any unspent 2017 Surf City 10 funds.
B. On or before April 1, 2018, the City will provide a full accounting of HOAG
funds obtained for Program staff salaries, and will generate a pro-rata check
made payable to PS-S for any unspent funds for 2018 (FY17-18).
C. Upon receipt of HOAG Funding for Program as agreed upon in the HOAG
MOU, City will generate a reimbursement check from the HOAG funding
made payable to PS-S in the amount of$20,000 for 2019 (FY 18-19).
D. For the duration of this MOU, as a City co-sponsored event, City will
provide space at the Senior Center in Central Park for the PS-S Annual
Holiday Parry, waiving hourly room rental fees and billing for direct event
costs only, including but not limited to fees for staffing hours, set-
up/breakdown, and additional permit requirements.
E. For the duration of this MOU, City will provide space, if available, for
additional PS-S meetings and events at the Senior Center in Central Park in
accordance with the City Council-approved rate. PS-S will work directly
with Senior Center staff to coordinate event dates and complete appropriate
paperwork.
F. The City will assist PS-S in promoting the transition of the Program to a
private non-profit agency, utilizing the following:
17-6136/170422/DO 2
1. An article within the pages of the SPRING 2018 SANDS Community
Services Guide, announcing the transition of the program to a private
non-profit entity. The article will be written by PS-S and approved
by City staff and will be free of charge. The size and placement of
the article will be based on availability.
2, An article within the City Managers Newsletter in January/February
of 2018 announcing the transition of the program to a private non-
profit entity. The article will be written by PS-S and approved by
City staff.
3. A news release in January/February 2018, through the City Public
Information Office announcing the transition of the Program to a
private non-profit entity.
4. An article placed on the City Website for the duration of calendar
year 2018 announcing the transition of the program to a private non-
profit entity. The article will be written by PS-S and approved by
City staff.
5. The production and distribution of news releases and critical
marketing efforts, from the City Public Information Office
announcing the transition of the PS-S to the Hoag Hospital Center for
Healthy Living(October 2017) and the official separation from the
City (February/March 2018). The news releases will be written by
PS-S and approved by City staff.
6. The promotion of the PS-S website on the City Website by supplying
a link on the Community Services Home Page.
7. For 90 days after separation, City will configure all City email accounts
designated to the Program to auto respond with transition information
and link to PS-S email address provided by PS-S.
SECTION 3. OBLIGATIONS OF PS-S
The obligations of PS-S pursuant to this Agreement shall be as follows:
A. The date of separation for all PS-S Staff employed by the City will be
February 28, 2018.
17-6136/170422/DO 3
B. In an effort to generate program funding, PS-S will maintain existing
collaborative relationships and develop new partnerships, independent of the
City, with current and future potential philanthropic partners.
C. Upon receipt of accounting from City, PS-S will generate and submit to City
an appropriate invoice for any unspent funds from the 2017 Surf City 10.
D. Upon receipt of accounting from City, PS-S will generate and submit to City
an appropriate invoice for the remainder of the unspent HOAG funds for
calendar year 2018.
E. Upon City receipt of HOAG funding for Program for calendar year 2019,
PS-S will generate and submit to City an appropriate invoice for said funding
as specified in the HOAG MOU.
F. For the duration of this MOU, PS-S will submit a written request for use City
facilities in advance. Written request will include the completion of all
required paperwork, and will be granted upon availability. Payment of any
applicable direct costs will be required.
G. PS-S will assist City in promoting the transition of the PSS program to a
private non-profit, by providing City with written information for the
following publications:
• An article within the pages of the SPRING 2018 SANDS Community
Services Guide, announcing the transition of the program to a private
non-profit entity.
• Article(s)within the City Managers Newsletter in January/February
of 2018 announcing the transition of the program to a private non-
profit entity.
• A news release in January/February 2018, through the City Public
Information Office announcing the transition of the program to a
private non-profit entity.
• An article placed on the City Website for the duration of calendar
year 2018 announcing the transition of the program to a private non-
profit entity.
1 7-6 1 3 6/1 70422/DO 4
• Promotion of the PS-S website on the City Website for the duration
of calendar year 2018.
SECTION 4. ACCESS TO THE PROJECT SELF-SUFFICIENCY
NAME, CITY MARKS AND LOGOS
Upon separation, City will officially release the ownership, branding, name and all
rights, if any, to the "Project Self Sufficiency/Project Self Sufficiency Foundation/Project
Self Sufficiency Orange County" (PSS/PSSF/PSSOC) name to PS-S. PS-S shall no
longer have the right to use the official Huntington Beach City logo, surfboard logo,
and City's"Surf City Huntington Beach" trademark for any reason.
SECTION 5. ACCESS TO PROJECT SELF-SUFFICIENCY
CONFIDENTIAL CLIENT INFORMATION
Upon separation of Program from City, City is to release all 2010—2018 client files
to PS-S. These files will become the property of PS-S, and when no longer needed by PS-
S will be disposed of in accordance with City record retention policies, which requires all
records to be retained from the inactive date plus five years. All client information from
2010-2018 client files will be available to City upon request. All client information prior
to 2010 will be disposed of in accordance with City record retention policies prior to
separation.
SECTION 6. HOLD HARMLESS
PS-S shall protect, defend, indemnify and hold harmless City, its officers,
officials, employees, and agents from and against any and all liability, loss, damage,
expenses, costs (including without limitation, costs and fees of litigation of every nature)
arising out of or in connection with performance of this MOU or its failure to comply
with any of its obligations contained in this MOU except such loss or damage which was
caused by the sole negligence or willful misconduct of City and PS-S shall similarly
require all subcontractors to waive subrogation.
SECTION 7. GENERAL LIABILITY INSURANCE
In addition to the workers' compensation insurance and PS-S's covenant to
indemnify City, PS-S shall obtain and furnish to City, a policy of general public liability
insurance, including motor vehicle coverage. Said policy shall indemnify PS-S, its
officers, agents and employees, while acting within the scope of their duties, against any
17-6136/170422/DO 5
and all claims arising out of or in connection with this Agreement, and shall provide
coverage in not less than the following amount: combined single limit bodily injury and
property damage, including products/completed operations liability and blanket
contractual liability of $1,000,000 per occurrence. If coverage is provided under a form
which includes a designated general aggregate limit, the aggregate limit must be no less
than $1,000,000. Said policy shall name City, its agents, its officers, employees and
volunteers as Additional Insured,and shall specifically provide that any other insurance
which may be applicable shall be deemed excess coverage and that Foundation's
insurance shall be primary.
Under no circumstances shall the above-mentioned insurance contain a self-
insured retention, or a "deductible" or any other similar form of limitation on the
required coverage.
SECTION 8. CERTIFICATES OF INSURANCE; ADDITIONAL
INSURED ENDORSEMENTS
Prior to commencement of this Agreement, PS-S shall furnish to City
certifications of insurance subject to approval of the City Attorney evidencing the
foregoing insurance coverage as required by this Agreement, and these certificates
shall:
(a) provide the name and policy number of each carrier and policy;
(b) state that the policy is currently in force; and
(c) promise to provide that such policies shall not be canceled or modified
without thirty (30) days' prior written notice of City; however, ten
(10) days'prior written notice in the event of cancellation for
nonpayment of premium.
PS-S shall maintain the foregoing insurance coverage in force during the
entire term of the Agreement or any renewals or extensions thereof or during any
holdover period.
The requirement for carrying the foregoing insurance coverage shall not
derogate from PS-S's defense,hold harmless and indemnification obligations as set
forth in this Agreement. City or its representatives shall at all times have the right to
17-6136/1 70422/DO 6
demand the original or a copy of any or all the policies of insurance. PS-S shall pay,
in aprompt and timely manner, the premiums on all insurance hereinabove required.
SECTION 9. ASSIGNING AS BREACH
Neither party shall encumber, assign, or otherwise transfer this MOU, or any
right or interest in this MOU, without the express written consent of the other party.
A consent by a party to one assignment or transfer to another person. Any
encumbrance, assignment or transfer, without the prior written consent of the other
party, whether it be voluntary or involuntary, by operation of law or otherwise, is void
and shall, at the option of the other party, terminate this MOU.
SECTION 10. TERMS BINDING ON SUCCESSORS
All the terms, covenants and conditions of this MOU shall inure to the benefit
of and be binding upon the parties and their successors and assigns. The provisions
of this Section shall not be deemed as awaiver of any of the conditions against
assignment hereinbefore set forth.
SECTION 11. CONFLICT OF INTEREST
PS-S shall employ no City official or any regular City employee in the work
performed pursuant to this MOU. No officer or employee of City shall have any
financial interest in this MOU in violation of the applicable provisions of the California
Government Code.
SECTION 12. NONDISCLOSURES/PRESS RELEASES
PS-S shall consult with City prior to issuing any press releases or otherwise
making any public statements with respect to this MOU,the transactions contemplated
herein, or matters arising herefrom.
SECTION 13. CUMULATIVE REMEDIES
The remedies given to the parties in this MOU shall not be exclusive but shall
be cumulative and in addition to all remedies now or hereafter allowed by law or
elsewhere provided in this MOU.
SECTION 14. WAIVER OF BREACH
The waiver by City of any breach by PS-S of any of the provisions of this
MOU, irrespective of the length of time for which such failure continues, shall not
1 7-61 3 6/1 70422/DO 7
constitute a waiver of such breach or a waiver of any subsequent breach by PS-S
either of the same or another provision of this MOU.
SECTION 15. FORCE MAJEURE -UNAVOIDABLE DELAYS
Should the performance of any act required by this MOU to be performed by
either City or PS-S be prevented or delayed by reason of an act of God, strike,
lockout, labor troubles, inability to secure materials, restrictive governmental laws or
regulations, or any other cause (except financial inability) not the fault of the party
required to perform the act,the time for performance of the act will be extended for a
period equivalent to the period of delay and performance of the act during the period
of delay will be excused.
SECTION 16. NOTICE
Any written notice, given under the terms of this MOU, shall be either
delivered personally or mailed, certified mail, postage prepaid, addressed to the party
concerned, as follows:
CITY PROJECT SELF-SUFFICIENCY
Director of Community Services Project Self-Sufficiency Orange County
City of Huntington Beach 18685 Main Street,PMB#A-109
2000 Main Street,P.O. Box 190 Huntington Beach,CA 92648
Huntington Beach, CA 92648 TaxID #33-0597719
Phone: (714)536-5291
If a party desires to change the address for notices set forth herein, said party
will provide 30 days advance written notice to the other party of any such change.
SECTION 17. ATTORNEY'S FEES
In the event suit is brought by either party to enforce the terms and provisions
of this MOU or to secure the performance hereof, each party shall bear its own
attorney's fees. The prevailing party shall not be entitled to recover its attorney's fees
from the non-prevailing party.
SECTION 18. CONTROLLING LAW AND VENUE
The rights and liabilities of the parties, and the interpretation and construction
of this MOU, shall be determined in accordance with the laws of the State of
1 7-6 1 3 6/1 70422/DO 8
California. Any controversy arising out of or under this MOU, if litigated, shall be
adjudicated in a court of competent jurisdiction in Orange County, California.
SECTION 19. SECTION TITLES
The section titles in this MOU are inserted only as a matter of convenience
and for reference, and in no way define, limit or describe the scope of intent of this
MOU or in any way affect this MOU.
SECTION 20. TIME OF ESSENCE
Time is of the essence with respect to all provisions of this MOU in which a
definite time for performance is specified including, but not limited to, the expiration
of this MOU.
SECTION 21. SURVIVAL OF INDEMNITIES
Termination of this MOU shall not affect the right of City to enforce any and
all indemnities given or made by PS-S under this MOU, nor shall it affect any
provision of this MOU that expressly states that the provision shall survive
termination thereof.
SECTION 22. NONLIABILITY OF CITY OFFICIAL, EMPLOYEES
OR AGENTS
No elective or appointed City or City-affiliated board, commission or member
thereof, or officer, official, employee or agent of City shall be personally liable to
PS-S, its successors and assigns, of any default or breach by City under this MOU or
for any amount which may become due to PS-S, its successors and assigns, under
this MOU or for any obligation of City under this MOU.
SECTION 23. MOU IN WRITING
This MOU contains and embraces the entire agreement between the parties
hereto and neither it nor any part of it may be changed, altered, modified, limited or
extended orally or by any other agreement between the parties unless such agreement
be expressed in writing, signed and acknowledged by City and PS-S, or their
successors in interest.
SECTION 24. PARTIAL INVALIDITY
Should any provision of this MOU be held by a court of competent
jurisdiction to be either invalid, void, or unenforceable, the remaining provisions of
1 7-6 1 3 6/1 70422/DO 9
this MOU shall remain in full force and effect unimpaired by the holding, so long as
the reasonable expectations of the parties hereto are not materially impaired.
SECTION 25. ENTIRETY
The foregoing sets forth the entire agreement between the parties.
IN WITNESS WHEREOF, the parties hereto have caused this MOU to be
executed by and through their authorized officers the day, month and year first above
written.
PROJECT SELF-SUFFICIENCY, CITY OF HUNTINGTON BEACH,
a non-profit 501 c3 Charitable a municipal c rpora`tion of th ate
Organization of California It
By C Mayo
print name
ITS: (circle one) Chairman/President/Vice ,City Clerk 2= a/sj/g
President
INITIATED A A OVED:
AND
By: Dire for of Co munity Services
print name
ITS: (circle one) Secretary/Chief Financial REVIE D APPROVED:
Officer/Asst. Secretary - Treasurer
qty Manager
APPROVED FORM:
City Attorney p�w 1Z,\(,kn
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l 7-613 6/170422/DO 10
DATE
��. CERTIFICATE OF LIABILITY INSURANCE �t AT.(M(MMtOD/YYYY)
THIS CERTIFICATE is ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must Have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION is WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsements.
PRODUCER CONTACT
NAME: Ellen Kara et an
Arthur J.Gallagher&Co. PHONE g18.539.8607 FAX 818.539.8707
Insurance Brokers Of CA.Inc.LIC#0726293 E-MAIL ,Ellen Kara et
505 N Brand Blvd, Suite 600 _ P yan@ajg.com
Glendale CA 91203 INSURERS AFFORDING COVERAGE NAIC X
INSURER A:NOn roflts'Insurance Alliance of CA
INSURED PROJSEL-01 INSURER B:
Project Self Sufficiency Foundation INSURER C:'
18685 Main St.#A109
Huntington Beach CA 92648 INSURER D:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1870310911 REVISION NUM13E :
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMlO ADDLISUBRI OY� MWDCmYY LIMITS
A X COMMERCIAL GENERAL LIABILITY Y 2017-22202 1118f2017 111812018 EACH OCCURRENCE $1,000,000
CLAIMS-MADE M OCCUR DAMAGE PREMISES'Sfe. TED
-Ea occurrence $500,000
MED FRCP(Any oneperson) $20,000
PERSONAL&ADV INJURY. $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X PECT LOC PRODUCTS-COMP/OP AGG $2,000.000
POLlCY❑
OTHER: $
A AUTOMOBILE LIABILITY 2017-22202 11/8(2017 1118/2018 O BINEDIdentS MIT—
(Ea $1,000,000
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
HIRED NON-OWNED PRO PERTY DAMAGE
X AUTOS ONLY X AUTOS ONLY Par oxidant $
UMBRELLA LIAB OCCUR {p� EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE layWHUtNKTINON
p AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION CITY PER OTH-
AND EMPLOYERS'.LIASILITY .STATUTE ER
ANY PROPRIETORIPARTNER/EXECUTIVE Y��/A E.L.EACH ACCIDENT $ '..
OFFICERIMEMBER EXCLUDED9
(Mandatory in NH) E.L.-DISEASE-EA EMPLOYE $
I(yes describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) `
City of Huntington Beach,its officers,elected or appointed officials,employees,agents and volunteers are named additional Insured with
respect to the operations of the named insured.Such insurance is Primary.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Huntington Beach, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
2000 Main Street, ACCORDANCE WITH THE POLICY PROVISIONS.
Huntington Beach,CA 92648
A`UT,HnO�R.�IZEDREP ESENTATIVE
@ 1088-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of,ACORD
POLICY NUMBER: 2017-22202 COMMERCIAL GENERAL LIABILITY
Named Insured: Project Self-Sufficieny Foundation CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)Or Organization(s);
City of Huntington Beach,its officers,elected or appointed officials,employees,agents and volunteers
Information required to complete this Schedule,if not shown above,will be shown in the Declarations.
A. Section It—Who Is An Insured Is amended to B, With respect to the Insurance afforded to these
Include as an additional Insured the person(s)or additional insureds,the following Is added to
organlzatlon(s)shown in the Schedule, but only Section III—Limits Of Insurance:
with respect to liability for"bodily Injury","property
damage"or"personal and advertising injury" If coverage provided to the additional Insured is
caused,In whole or in part,by your acts or required by a contract or agreement,the most we
omissions or the acts or omissions of those acting will pay on behalf of the additional Insured is the
on your behalf: amount of insurance:
1. In the performance of your ongoing operations; 1. Required by the contract or agreement;or
or 2. Available under the applicable Limits of
2. In connection with your premises owned by or Insurance shown in the Declarations;
rented to you, whichever is less.
However: This endorsement shall not increase the
1. The insurance afforded to such additional applicable Limits of Insurance shown in the
insured only applies to the extent permitted by Declarations.
law;and
2. If coverage provided to the additional Insured is
required by a contract or agreement,the
Insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional Insured,
CG 20 26 04 13 GO Insurance Services Office,Inc.,2012 Page 1 of 1
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CITY OF HUNTINGTON BEACH
2000 Main Street, Huntington Beach, CA 92648-2702
Huntin`� "4 each ,
ti-
Declaration of Non-Employer Status
The State of California requires every enterprise or business to provide workers
compensation insurance coverage. If you have no employees, you may make a
declaration to that effect by completing and signing this form and returning to:
City of Huntington Beach
2000 Main Street
Huntington Beach, CA 92648-2702
1 certify that in the performance of the activity or work for which this permit is
issued, I shall not employ any person in any manner so as to become subject to
California Workers' Compensation Insurance requirements.
I authorize the City of Huntington Beach to immediately and retroactively
revoke the license or permit issued under this declaration if I hire any
employee(s) or become subject to the provision of the laws requiring Workers'
Compensation Insurance.
Company / Organization: rro i e G e4 c)
Address: 8 M ct 'A �n+-+,,
Applicant [please print]: C � e-r+ tf_ -'> C-GHQ,A C)c._
Title, if any: _Prt_S i 4-c,^ �, Q mar d.F D rrv-clV,rS i
Applicant's Signature: 4*t4�
Date Signed: iZ gr Zl g
2.—be N hon Tele e Number: �� z3 2^`/ - z 3
p 7 I
ATTACHMENT#7
ity CITY OF HUN°][ INGTON BEACH
E 2000 Main Street, Huntington Beach, CA 92648-2702
Hunting„ ;" euch.� DECLARATION OF PERMITTEE
I
1 certify that no vehicle(s) will be used or operated in the performance of the
task(s) or event(s) for which this permit is granted_
I authorize the City of Huntington Beach to immediately and retroactively
revoke the license or permit issued in connection with or in the performance of
said task(s) or events(s) if any vehicle(s) is used.
Signature of Permittee: �i� -----
Print Name: C G/C
i
Company Name (if applicable): Pro,( e. C4 — Se- —Sv -('ic ,'o,��, c�
i
Date Signed.• 10
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16407 EXHIBIT 1
ATTACHMENT#5
City of Huntington Beach
2000 Main Street ♦ Huntington Beach, CA 92648
(714) 536-5227 ♦ www.huntingtonbeachca.gov
•!1,1909 P' �
,Office of the City Clerk
Robin Estanislau, City Clerk
February 8, 2018
Project Self-Sufficiency
Project Self-Sufficiency Orange County
18685 Main Street, PMB #A-109
Huntington Beach, CA 92648
Good afternoon:
Enclosed is a fully executed copy of the "Memorandum of Understanding Between the City
of Huntington Beach and Project Self-Sufficiency."
Sincerely,
7i61
Robin Estanislau, CIVIC
City Clerk
RE:ds
Enclosure
Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand